Ready today for the future of
consumer-directed health
plan solutions
32.25.102.1 (3/09)
Aetna
HealthFund®
Health
Reimbursement
Arrangement (HRA)
2
3
Support member engagement

Help members become better health care consumers

Educate members on the process

Enable behavior change

Support doctor-patient relationships

Provide personalized information

Make connections for optimal health
©2009 Aetna
4
Aetna HealthFund®

High deductible health plan, Health Reimbursement Arrangement( HRA)*,
Health Savings Account (HSA)*, Aetna performance networks

Decision tools for value-based purchasing

Health incentives

Health care transparency

Integrated care management

Effective communications and education
*HRAs and HSAs are currently not available to HMO members in Illinois
©2009 Aetna
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Health benefits - current environment

Health care costs continue to rise

Employers looking for solutions and savings

New competitive options emerging

Legislative and political impact

Consumer’s role changing

Result – CDHP (Consumer-Directed Health Plans)
©2009 Aetna
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An industry transformation

Greater member responsibility

Promotes consumer engagement

Can improve employee satisfaction

Saves employers money

Drives cost down
©2009 Aetna
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®
The Aetna HealthFund
Health Reimbursement Arrangement (HRA)*

Fully integrated systems, including Pharmacy

Full product and funding spectrum

Actuarial modeling capabilities

Plan design flexibility

Full medical management services

Personalized Aetna Navigator® consumer decision support tools

Favorable network discounts

Monthly member statements
*HRAs are currently not available to HMO members in Illinois
©2009 Aetna
8
Aetna HealthFund HRA*

Fund integrated with deductible-based medical plan
–
Fund
•
•
•
•
•
–
Medical plan
•
•
•
•

Established by employer
Notional account / unfunded liability
Pays eligible out-of-pocket expenses
Balances roll over, option to cap
Fund reduces deductible (standard model)
Deductible
Coinsurance and/or copayments
100% preventive care, not subject to fund or deductible
Out-of-pocket maximum
Consumer tools and information
*HRAs are currently not available to HMO members in Illinois
©2009 Aetna
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*
*HRAs are currently not available to HMO members in Illinois.
10
*
Helps you pay for eligible out-of-pocket expenses
……………………….
Employer funded each plan year
*HRAs are currently not available to HMO members in Illinois.
11
*
You pay this amount
before your health
plan begins to pay
for eligible
expenses
Helps you pay for eligible out-of-pocket expenses
……………………….
Employer funded each plan year
*HRAs are currently not available to HMO members in Illinois.
12
*
You pay this amount
before your health
plan begins to pay
for eligible
expenses
Once you meet your
deductible, your health
plan pays a larger %
of eligible costs while
you pay a smaller %
Helps you pay for eligible out-of-pocket expenses
……………………….
Employer funded each plan year
*HRAs are currently not available to HMO members in Illinois.
13
Employer-established fund





Various fund amounts available
Generally half deductible amount
Fund rollover options
Fund typically forfeited at termination of employment or termination of plan
Health fund can be limited to:
–
–



©2009 Aetna
Traditionally covered PPO expenses
IRS Section 213 deductible health expenses (ASC)
Rollover maximum
One fund per family, not member
Fund-tiering available
14
HRA* common plan designs

Underlying Plan deductible ranges
–
–

–
–


($1,000 / $1,500 / $2,000)
($2,000 / $2,500 / $3,000)
Individual range:
Family range:
$2,000 - $4,000
$4,000 - $8,000
Fund ranges
–

$500 - $3,000
$1,500 - $9,000
Out-of-Pocket maximum
–

Individual range:
Family range:
Individual range:
Family range:
$350 - $1,000
$750 - $3,000
($500 / $750 / $1,000)
($1,000 / $1,500 / $2,000)
Underlying plan coinsurance levels: 80/60, 90/70 or 100/70
100% preventive care
Tiering
–
–
Standard is 2-tier (Individual or Family)
Each tier has one deductible to meet for the entire group
Note: Effective member responsibility is a result of utilizing many of the plan design components as opposed to each component individually.
* HRAs are currently not available to HMO members in Illinois.
©2009 Aetna
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Preventive care coverage

Generally 100% covered for each individual
–
©2009 Aetna
Does not apply to fund or deductible

Preventive care schedule on Aetna Navigator®

Covers medical services such as routine physicals,
immunizations, screening, well-woman exams, well-child visits

Encourages employee to obtain preventive care
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HRA* medical plan

Fund
–
–
–
–


Fund pays member responsibility (deductible and member coinsurance)
Fund pays until exhausted (may or may not reduce deductible)
Before-fund deductible
fund
coinsurance (ASC only)
Deductible
fund
deductible
coinsurance
PPO, Aetna Choice® POS II, Open Access Aetna SelectSM
Fully insured plans
–

coinsurance options
Self-funded plans (ASC)
–

deductible
PPO, Open Access Managed Choice® (POS) and Aetna Choice POS (HMO)
Optional standalone or integrated pharmacy and dental
Flexible plan designs
*HRAs are currently not available to HMO members in Illinois
©2009 Aetna
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Additional options & features

Dental integration

Long Term Care premium reimbursement

Chronic & preventive medications

Incentives

Hybrid funding arrangement (insured plan, ASC fund)

Simple Steps To A Healthier Life®

Informed Health® Line

Medical management programs

Aexcel®
©2009 Aetna
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Pharmacy integration

Real-time claim adjudication

Discounted cost of prescriptions applied to fund and/or deductible depending
upon fund model

Once fund exhausted and deductible met, pharmacy plan can be:
–
–
Same or lower coinsurance level as medical, or
Copay plan

Participating pharmacy knows whether to collect anything from member –
handled at point of sale with no balance billing

Price-A-DrugSM tool available to assist members
©2009 Aetna
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Comparing HRA*, HSA*, FSA
Feature
Health Reimbursement
Arrangement (HRA* or RRA)
Health Savings
Account (HSA*)
Flexible Spending
Account (FSA)
Eligibility
All eligible employees
Individual covered by
high deductible health
plan (HDHP)
All eligible employees
Contributor
Employer only
Employer, individual or
both
Employer, associate or both
Roll-Over
Usually yes, but at employer
discretion
Yes
No
Tax Advantaged
Yes
Yes
Yes
Portability
No, forfeit upon termination
Employer has option to roll to RRA
on retirement
Yes
No
Ability to Earn
Investment Income
No
Yes
No
Rx Integration
for HDHP
Available
Required
N/A
Note: HSAs can be purchased with a “limited purpose” HRA/FSA, post deductible HRA/FSA, suspended HRA, retirement HRA
*HRAs and HSAs are currently not available to HMO members in Illinois
20
Aetna HealthFund® HRA* / HSA*
High-Deductible Health Plan/HSA
Health Reimbursement Arrangement
819 customers
• 133 National
• 123 Key
• 290 Select
• 68 Small Group
9,712 customers
• 131 National
• 146 Key
• 350 Select
• 9,085 Small Group
51 full replacement plans*
52 full replacement plans*
~401K members HDHP/HSA
~ 882K members
~75K members HDHP only
* >1,000 lives
Aetna’s HRA/HSA growth
1/02 – ~482
1/03 – ~39K
1/04 – ~160K
1/05 – ~359K
1/06 – ~463K
1/07 – ~826K
1/08 – ~1.29M
As of 12/2008
*HRAs and HSAs are currently not available to HMO members in Illinois
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Plan sponsor tools

Cost modeling

Pricing tool

Reporting
©2009 Aetna
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Consumer tools
Aetna Navigator®
Plan Selection & Cost Estimator Tool
©2009 Aetna
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Consumer tools

DocFind®

Hospital Comparison Tool

Plan Selection & Cost Estimator

Transparency Suite of Tools – Price and Clinical Quality

Cost of Care Tool

Healthwise® Knowledgebase

Informed Health® Line

Aetna InteliHealth®

Simple Steps To A Healthier Life®
©2009 Aetna
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Keys to success
Set a strategy
 Appropriate benefit structure, information and tools
 A business culture actively communicating health care
engagement concepts
Member responsibility
 $750 - $1000 bridge between deductible and employer
fund/account contribution with appropriate coinsurance
 Update benefit offerings regularly to stay in-sync with the overall
strategy
Engagement
 Multi-year, cost controlling strategies that engage employees in
managing their health
 Provide information and tools for decisions about health,
spending and overall wellness
©2009 Aetna
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Keys to success
Wellness
 Preventive care covered at 100%
 In-depth education and communication including completion
of Health Assessments
Steerage to CDHP
 CDHP as the lowest cost option
 Lowering the required employee premium contribution
and/or offer higher fund/account contribution
©2009 Aetna
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Engaging your employees and
enabling behavior
Four phases to an effective communications strategy
1
2
3
4
Pre-Enrollment
Enrollment
Post-Enrollment
Ongoing support
 Engage Management
 Contribution strategy
 Reinforce

Motivate employees
 Advantages/Features
 Educate
 Remind

Keep them engaged
 Employee role
 Emphasize accountability
 Update

Reintroduce resources
©2009 Aetna
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Why Aetna?

Experience

Innovation

Consumer communication and education

Integration

Plan design

Analysis and reporting
©2009 Aetna
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Join the Change
Healthier employees
+
+
=
Higher levels of engagement
Innovative, client-centered solutions
Lifelong optimal health
Lower medical costs
Higher productivity
Ready today for the future of health care
29
This material is for information only. Providers are independent contractors and are not agents of Aetna.
Provider participation may change without notice. Aetna does not provide care or guarantee access to
health services. Aetna HealthFund HRAs are subject to employer-defined use and forfeiture rules, and
are unfunded liabilities of your employer. Fund balances are not vested benefits. Investment services are
independently offered through JPMorgan Institutional Investors, Inc., a subsidiary of JPMorgan Chase
Bank. Health information programs provide general health information and are not a substitute for
diagnosis or treatment by a physician or other health care professional. Information is believed to be
accurate as of the production date; however, it is subject to change. For more information about Aetna
plans, refer to www.aetna.com. Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK
GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of
subsidiary companies, including Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the
Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health
Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151
Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products.
©2009 Aetna Inc.
32.25.102.1 (3/09)
30
Appendix
©2009 Aetna
31
HRA* Workflow (Medical HRA* pays first)
Member sees
Provider
- presents ID card
(no copay)
- Member pays $0
Is there enough money in
the HRA Fund to cover the
Member responsibility?
No
Provider
bills
Aetna.
Aetna pays Provider whatever it
can, if anything, from the Fund
and tells the Provider the exact
amount to bill the Member.
Yes
Provider bills
Member.
HRA$
Member pays Provider.
Aetna pays Provider
directly from the Fund.
Member owes $0.
*HRAs are currently not available to HMO members in Illinois.
32
Aetna adjudicates
claim and
determines what
the Member
owes.
HRA* – how it works
The Plan Pays
10%
*HRAs are currently not available to HMO members in Illinois.
33
30%
HRA* – how it works
Member Responsibility
10%
*HRAs are currently not available to HMO members in Illinois.
34
30%
HRA* – how it works
The Plan Pays
Fund
Member Responsibility
10%
*HRAs are currently not available to HMO members in Illinois.
35
30%
HRA* – how it works
The Plan Pays
Fund
Member Responsibility
Fund
Helps
Pay
10%
*HRAs are currently not available to HMO members in Illinois.
36
30%
HRA* example year 1
**
10%
*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by
an actual participant.
37
30%
HRA* example year 1
**
10%
*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by
an actual participant.
38
30%
HRA* example year 1
**
10%
*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by
an actual participant.
39
30%
HRA* example year 2
**
10%
*HRAs are currently not available to HMO members in Illinois.
** For illustrative purposes only. Does not reflect events experienced by
an actual participant.
40
30%